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Includes what doctor asks about health history. Covers other problems like heart attack, high blood pressure, and diabetes. Also medicines you take, illnesses in your family. Covers listening to heart and lungs, checking legs and belly for swelling.

History and Physical Exam for Heart Failure

Exam Overview

Your medical history includes anything about
your past and present health—conditions you used to have or conditions you have
now. Tell your doctor about medical problems of any type, including any surgery
that you have had. When giving your doctor your medical history, be complete
and detailed in your descriptions. Even if an illness is completely gone or
does not seem important to you, knowing about that problem may help your doctor
diagnose
heart failure. Also, knowing all of your past
and present medical problems will help your doctor decide the best way to care
for your condition.

As part of your medical history, you should
also review with your doctor the medicines that you currently are taking. This
is best done by bringing an updated list of the names and dosages of all the
medicines that you are taking.

In addition to the medical
conditions that you have had or now have, your doctor will want to know about
several factors that increase your risk for developing heart failure. Since
coronary artery disease (CAD) is a cause of
heart failure, risk factors for heart failure include the major risk factors
for CAD, such as smoking, diabetes, high total
cholesterol or LDL cholesterol, high blood pressure,
advanced age, and being male. Drinking too much alcohol is also a risk factor
for heart failure. Your doctor will take into account all of the risk factors
you have when trying to determine whether you have heart failure. The more risk
factors you have and the more severe they are, the greater your chance of
having heart failure.

If other members of your family have
developed heart failure at a young age, you may be at risk for developing a
genetic form of heart failure. In addition, if several members of your family
also have had diseases that are risk factors for heart failure, such as
hypertension or diabetes, you may be at increased risk
for those diseases, which also increases your risk for developing heart
failure.

During a medical history and physical exam, the doctor
will ask about symptoms (such as shortness of breath, swelling, and coughing),
recent or past illnesses (such as heart attack, viral illness, high blood
pressure, and diabetes), physical activity, breathing, sleeping, eating, and
other routine activities.

The parts of the physical exam that are
most helpful in diagnosing heart failure are:

Measuring blood pressure and pulse
rate.

Checking the veins in the neck for swelling or evidence of
high blood pressure in the veins that return blood to the heart. Swelling or
bulging veins may indicate right-sided heart failure or advanced left-sided
heart failure.

Listening to breathing (lung
sounds).

Listening to the heart for murmurs or extra heart
sounds.

Checking the abdomen for swelling caused by fluid buildup
and for enlargement or tenderness over the liver.

Checking the legs
and ankles for swelling caused by fluid buildup (edema).

Measuring
body weight.

Why It Is Done

The physical exam is a regular part
of almost any visit for heart problems.

Results

Usually, signs of some heart condition are
present, such as high blood pressure or a heart murmur that means
heart valve disease.

If you have symptoms
typical of heart failure, the physical exam may be all that your doctor needs
to make the diagnosis. But you will have additional tests to determine the
specific cause and type of heart failure so that you can receive appropriate
treatment.

Normal

Lung and heart sounds are normal, blood
pressure is normal, and you have no sign of fluid buildup or swollen veins in
the neck.

You may have further exams or tests to check for other
causes of symptoms.

Abnormal findings that suggest heart failure

High blood pressure (140/90 mm Hg or above)
or low blood pressure is present. Low blood pressure could be a sign of
late-stage heart failure.

A third heart sound (indicating abnormal
movement of blood through the heart) is heard. Heart murmurs may or may not be
present.

The impulse normally felt from the lower tip of the heart
(apex) is not felt in its normal position on the chest wall, suggesting
enlargement of the heart.

Swollen neck veins or abnormal movement
of blood in the neck veins suggest that blood may be backing up in the right
ventricle.

Noises (pulmonary rales) such as bubbling or crackling
are heard, which may point to fluid buildup in the lungs. Your doctor uses a
stethoscope to hear these noises while you take deep breaths.

You
have a swollen liver or have pain in the right upper abdomen, loss of appetite,
or bloating. This suggests that blood may be backing up into the
body.

You have swelling in your legs, ankles, or feet or in the
lower back when you lie down, and it is clearly not caused by another
condition. Fluid buildup first occurs during the day and goes away overnight.
As heart failure becomes worse, fluid buildup may not go away.

Some people with early symptoms of heart failure have
no physical findings.

What To Think About

A diagnosis
of heart failure depends on the whole picture of physical findings, symptoms, and tests.

If physical findings and your medical history strongly
suggest heart failure, you most likely will have a chest X-ray, an
echocardiogram, and
electrocardiography to evaluate the heart size, shape,
and function and to evaluate the lungs for signs of fluid buildup.

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